Healthcare bill raises fear of denied coverage among legal immigrants

As Congress moves closer to passing legislation that will expand health insurance coverage to 30 million Americans, many immigrant rights advocates worry that proposed reforms will leave large numbers of legal immigrants without insurance.

At issue is whether Congress will retain a 1996 welfare reform law requiring legal, non-citizen immigrants to wait five years before they become eligible for federal benefits and extend it to a waiting period for subsidies as well. If retained, (as proposed in the Senate bill) it could affect more than one million legal immigrants, according to an October 2009 report by the Migration Policy Institute (MPI).

Also worrisome are strict screening processes proposed in the House bill used to prevent undocumented immigrants from obtaining benefits. Immigrant rights advocates question the effectiveness of these processes, which they say will force legal immigrants to “jump through hoops” to prove their eligibility and could delay critical medical services to those who need them most.

Francisco I. and his family emigrated from Chile seven years ago. As legal residents who are not yet citizens, they pay the same taxes as citizens and are subject to the same laws. Last year Francisco’s father, an engineer, lost his job and with it the family healthcare benefits. He has since found work but his employer does not offer insurance.

When Francisco recently became ill with a high fever, the family could not afford a doctor. After several days, his father found a doctor who agreed to treat Francisco for less than a normal office visit.

“We still ended up paying about $150 just to get somebody to see what was wrong with me and another $150 for medicine,” he says.

Now he worries about what would happen if something more serious were to happen.

“It’s not just getting sick - it’s accidents that worry me the most. Like if I fall and break an arm or get something like a concussion or get in a car crash.”

Current U.S. Census Bureau figures show that 24 million immigrants now live in this country. About 12 million are legal residents, like Francisco. Although most legal immigrants are employed, the MPI report found that 38 percent work at small firms of 25 employees or less. Only one out of three of these workers is insured compared with seven out of 10 U.S.-born workers in similar-sized firms.

While Congress will likely mandate employers to provide insurance for their workers, small firms will probably be exempted from these mandates.

Experts say this will force millions of immigrant workers, many who live below the federal poverty line, to purchase health insurance themselves or turn to already jammed emergency rooms and clinics for medical care.

“Let them buy their own healthcare,” Evelyn Miller, a spokesperson for the California Coalition for Immigration Reform argues. “Why should they go on public benefits?”

The CCIR, established in 1992, is a group who seeks to have current immigration laws enforced, borders secured and illegal aliens deported, Miller explains. She believes that the five-year waiting period should be retained and that only citizens should be eligible for federal healthcare benefits.

“When people come to this country legally to join a family member or they are sponsored by somebody who is a citizen, the sponsor signs an affidavit claiming that the legal immigrant will not be a drain on our public benefits,” Miller says. “So they’re not supposed to get public benefits.”

She says that legal immigrants get a lot of benefits that U.S. citizens do not.

“They go in and try to get food stamps or housing subsidies and all they have to do is show that they have no funds and no income and they get it right away. It’s really a travesty,” she says.

And what about those immigrants who can’t afford to purchase health insurance?

Some will turn to free clinics like the Lestonnac Free Clinic in Orange County, Calif., which sees more than 3,500 patients with about 14,000 visits a year, according to Executive Director Ed Gerber.

Founded in 1979 by a Catholic nun, Lestonnac is funded primarily by private foundations and community donations, with about five percent of the funding coming from the state. Medical services are donated by thirty physicians and fifteen dentists, whom Gerber calls “the backbone of the clinic.”

The clinic’s primary mission is to help the uninsured, whether they are in this country legally or not, Gerber says, so they never question a patient’s documentation.

“We’re not a government agency; we don’t care what their issue is,” he says.

He stresses the importance of providing medical treatment and testing to all immigrants.

“We don’t know who is in line in front of us in the grocery store. We don’t know if this person has tuberculosis or if this person has the swine flu, which is so prominent today,” he says. “We really need to try to take care of these people, especially the new population of immigrants coming in to California, so that we’re not spreading disease to everybody else.”

Fear is a daily part of life for illegal immigrants who fear deportation and for legal immigrants who fear legal entanglements with their citizenship process, so they seek medical care less often than citizens.

A 1997 study by The Kaiser Commission found that citizen children, on average, had over three times as many visits to the emergency room as non citizen children of non citizen parents.

Recently, Gerber has seen a proliferation of minority-run clinics that exploit the fear of newly-arrived immigrants by charging enormous prices for lab work, x-rays, ultra-sounds and other often unnecessary services.

“I find it deplorable that there are doctors out there that start clinics and they rip off their own people,” he says. “These people are afraid to come to community clinics like us because they’re illegal and they’re uncomfortable and they’re afraid we’re going to turn them in. To me, this is an enormous problem that’s happening here in Orange County. They’re just raping their own people and it needs to stop.”

Chilean immigrant Francisco knows people who have avoided going to the emergency room out of fear. They think that a border patrol agent is going to show up at the emergency room. And after they’re done getting their healthcare they’ll get kicked out,” he says.

His own fear of jeopardizing his pending citizenship is so strong that he refused to be identified for this article.

Recent government figures show that more than 20,000 people immigrated legally to Orange County last year, bringing the total foreign-born population to more than 900,000. To meet the growing demand for healthcare, Lestonnac has opened two new clinics – one in Santa Ana and another in Los Alamitos. Plans are underway to open two more in January 2010.

Despite the fact that President Obama’s goal of “healthcare for all Americans” may soon become a reality, Gerber is skeptical that the programs will impact the people he treats at his clinics.

“My hope is that it will make healthcare better. That’s all of our dreams – that whatever Congress does, it actually works,” he says. “As far as impacting us, I don’t particularly see how any of this funding is going to come to our facility. It’s not designated to come to free clinics-it’s going to hospitals and medical groups and FUHC clinics.”

So Gerber’s work providing healthcare to the uninsured will continue.

“Even if this passes there’s still going to be a large gap of people that are still gonna need help.”